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<div id="ctl06_ctl00_contentPane" class="content"> <div id="ctl06_ctl00_ctl00_divArticleDetail" class="articleModule module"> <div id="ctl06_ctl00_ctl00_schemaData" class="schemaData"> </div> <div id="ctl06_ctl00_ctl00_divArticleModule" class="articleModule module"><div name="section561173" class="byline clearfix" id="section561173"> <div class="ArticleDetailDatePublished"> Wednesday, June 5, 2013 </div><div id="embeddedCode" class="embeddedcode" > <div class="sharing"> <span class="tweets"> <a href="http://twitter.com/share" class="twitter-share-button" data-count="horizontal" data-via="ophthalmologyweb">Tweet</a> </span> <span class="facebook"> <div id="fb-root"></div><script src="https://connect.facebook.net/en_US/all.js#appId=256518057696581&xfbml=1" type="text/javascript"></script><fb:like href="" send="false" layout="button_count" width="90" show_faces="true" font=""></fb:like> </span> </div></div></div></div> <div id="ctl06_ctl00_ctl00_divPaging" class="paging"> </div> <div 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Friedman, M.D." /> </div> <div id="ctl06_ctl00_ctl02_divArticleModule" class="articleModule module" itemscope="" itemprop="articleBody"><div name="section561172" class="subtitle" id="section561172"> <p></p></div><div name="section561174" class="articleImage" id="section561174"> <img src="https://media.ophthalmologyweb.com/m/27/article/138219-187x140.jpg" alt="Pearls for Secondary Intraocular Lens Implantation" width="187" height="140" itemprop="image" /></div><div name="section561175" class="mainContent" id="section561175"> <div class="ArticleDetailAuthorDetails"> <div class="author"> <div class="name" rel="author"> <a class="authorArticleLink" href="https://www.ophthalmologyweb.com/1319-AuthorProfile/1718-Neil-J-Friedman-M-D/" title=" Neil J. Friedman, M.D."><img src="https://media.ophthalmologyweb.com/m/27/author/1718.jpg" class="authorImage" alt=" Neil J. Friedman, M.D." /><div class="author-name"> Neil J. Friedman, M.D. </div></a> </div><div class="department"> </div><div class="aboutAuthor"> <a class="authorArticleLink fn" href="https://www.ophthalmologyweb.com/1319-AuthorProfile/1718-Neil-J-Friedman-M-D/" title="About Author">About Author</a> </div> </div> </div><p>Secondary IOL implantation was traditionally performed for aphakia but is now most commonly done during IOL exchange surgery.</p> <h4>Preoperative Evaluation</h4> <p>Careful slit-lamp biomicroscopy with attention to:</p> <ul> <li>Corneal endothelium</li> <li>IOP</li> <li>Presence of vitreous in anterior chamber</li> <li>Angle and iris abnormalities</li> <li>Presence and adequacy of capsular support, macula and peripheral retina, and optic nerve</li> </ul> <h4><a href="https://www.ophthalmologyweb.com/Cataract/5260-Intraocular-Lenses-IOL/">IOL Selection</a></h4> <p>Posterior Chamber:</p> <ul> <li>Capsular bag: best location for <a href="https://www.ophthalmologyweb.com/Cataract/5829-Sutured-Secondary-Intraocular-Lenses-IOL/">IOL</a> if bag is intact with adequate support</li> <li>Sulcus:</li> <ul> <li>Adequate capsular support: Does not require suture; this is the next best location after capsular bag. Capture IOL optic through intact anterior capsulotomy if present.</li> <li>Inadequate capsular support: Requires suture fixation to iris or sclera</li> <ul> <li>Iris suture: Modified McCannel suture, tie with Siepser knot</li> <li>Transscleral suture: Technically more difficult, longer procedure time, requires thorough anterior vitrectomy, risk of ciliary body hemorrhage and suture erosion.</li> </ul> </ul> <li>Iris fixated: Iris-claw lens easiest surgical technique and fewer complications; requires peripheral iridectomy; also may be fixated to posterior iris surface.</li> <li>Anterior chamber: Easier, faster and less traumatic than suture techniques; long-term results equivalent to sulcus with scleral suture fixation; requires peripheral iridectomy but may not require anterior vitrectomy; contraindicated if corneal endothelial damage, angle abnormalities, or glaucoma exists.</li> </ul> <h4>Surgical Technique</h4> <p>Posterior chamber:</p> <ul> <li>Iris fixation: Capture IOL optic through pupil, place two McCannel-style sutures with 9-0 polypropylene on a long curved needle, retrieving needle can be facilitated by docking in cannula, Siepser knot minimizes traction on iris and haptics.</li> <li>Scleral fixation: Numerous techniques with or without scleral flaps, secure with <a href="https://www.ophthalmologyweb.com/Refractive/6003-Ophthalmic-Suture/">suture</a> (9-0 polypropylene or 8-0 gortex on a long curved or straight needle) or glue. Safest techniques utilize 27-gauge hollow needle for precise positioning and docking/retrieving the suture needle. </li> </ul> <p>Iris-claw: Careful attention to centration during enclavation, must create peripheral iridectomy to prevent pupillary-block angle-closure glaucoma. Anterior chamber: constrict pupil, Sheet’s glide to facilitate insertion, push/pull-elevate-release haptic technique for proper footplate positioning in angle, must create peripheral iridectomy to prevent pupillary-block angle-closure glaucoma.</p> <h4>Reference:</h4> <p>Friedman NJ, Khater TT, Kohnen T, Koch DD. "Secondary Intraocular Lens Implantation." In: Tasman W, Jaeger EA. (eds): Duane's Clinical Ophthalmology. Volume 6. Philadelphia. Lippincott, Williams, & Wilkins Publishers. 2011.</p></div><div name="section561176" class="featuredLink" id="section561176"> </div></div> <div id="ctl06_ctl00_ctl02_divPaging" class="paging"> <div class="pager"><div class="pagingHolder module"><div class="pageTitle"></div><ul class="pages module"><li class="previousSection"><<</li><li class="previous"><</li><li class="next">></li><li class="nextSection">>></li></ul></div></div> </div> <div id="ctl06_ctl00_ctl02_divComments"> </div> </div> </div> </div> <div id="ctl06_ctl01_divContainer" class="container module default jsKitComments"> <div id="ctl06_ctl01_divHeader" class="header"> <h2> Comments</h2> </div> <div id="ctl06_ctl01_contentPane" class="content"> <div id="ctl06_ctl01_ctl00_staticHtml" class="staticHtmlModule module"><div id="disqus_thread"></div> <script type="text/javascript"> var disqus_shortname = 'ophthalmologyweb'; var disqus_identifier = window.location.pathname; var disqus_url = window.location.href; /* * * DON'T EDIT BELOW THIS LINE * * */ (function() { var dsq = document.createElement('script'); dsq.type = 'text/javascript'; dsq.async = true; dsq.src = 'https://' + disqus_shortname + '.disqus.com/embed.js'; (document.getElementsByTagName('head')[0] || document.getElementsByTagName('body')[0]).appendChild(dsq); })(); function disqus_callback() { $.vp.domFragments.contentPane.find('ul.artcleToolList li:last .comments span').text( $.vp.domFragments.contentPane.find('#dsq-num-posts').text()); } $(document).ready(function(){ var countDom = $.vp.domFragments.contentPane.find('ul.artcleToolList li:last').after('<li/>').next(); countDom.html('<a href="#disqus_thread " class="icon comments">Comments (<span>0</span>)</a>'); }); </script> </div> </div> </div> </div> </div> <div class="leftSidebarOuter module"> <div id="ctl06_leftSidebar" class="leftSidebar"> <div id="ctl06_ctl07_divContainer" class="container module default highlight"> <div id="ctl06_ctl07_divHeader" class="header"> <h2> Related Categories</h2> </div> <div id="ctl06_ctl07_contentPane" class="content"> <div id="ctl06_ctl07_ctl00_divArticleDetail" class="articleModule module"> <div id="ctl06_ctl07_ctl00_schemaData" class="schemaData"> </div> <div id="ctl06_ctl07_ctl00_divArticleModule" class="articleModule module"><div name="section561178" id="section561178"> <ul class="relatedProductCategories itemList"> <li><a title="Intraocular Lenses (IOL)" href="https://www.ophthalmologyweb.com/Cataract/5260-Intraocular-Lenses-IOL/"><h3> Intraocular Lenses (IOL) » </h3><p>Intraocular lens (IOL) placement is the most common eye surgical procedure performed. 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